Abstract
BackgroundPlatinum-based systemic chemotherapy is the treatment of choice for patients with advanced urothelial carcinoma (UC). Although no chemotherapeutic regimen is established as a second-line therapy, recent studies reported that methotrexate, vinblastine, Adriamycin and cisplatin (MVAC) elicited a significant response in patients who failed gemcitabine and platinum (GP) chemotherapy. We investigated the clinical factors useful for predicting a favourable response to MVAC in UC patients who failed GP.MethodsForty-five patients with advanced UC who received second-line MVAC chemotherapy after failure with first-line GP chemotherapy were enrolled in this study. Univariate and multivariate analyses based on Cox’s regression were performed to identify independent prognostic factors for progression-free survival (PFS) after second-line MVAC chemotherapy.ResultsThe median follow-up period after the first MVAC administration was 10.0 months. The median PFS and overall survival (OS) were 6.5 months (95 % confidence interval [CI]: 5.1–7.9) and 14.5 months (95 % CI, 7.4–21.4), respectively. The overall response rate was 57.8 %. The response to first-line GP chemotherapy (hazard ratio [HR], 2.500; p = 0.012) and patient age (HR, 1.047; p = 0.033) were predictors of PFS after MVAC chemotherapy.ConclusionsThe response to first-line GP chemotherapy and age were independent predictors of PFS in patients who received second-line MVAC chemotherapy. This report is the first to describe independent predictors of PFS after MVAC chemotherapy.
Highlights
Platinum-based systemic chemotherapy is the treatment of choice for patients with advanced urothelial carcinoma (UC)
A complete response (CR) was achieved in two patients (4.4 %) and a partial response (PR) in twenty-four (53.3 %)
Characteristics of good and poor responses to previous gemcitabine and cisplatin (GC) chemotherapy All included patients were divided into two groups: a good response group and a poor response group, according to the response to first-line gemcitabine and platinum (GP) chemotherapy
Summary
Platinum-based systemic chemotherapy is the treatment of choice for patients with advanced urothelial carcinoma (UC). No chemotherapeutic regimen is established as a second-line therapy, recent studies reported that methotrexate, vinblastine, Adriamycin and cisplatin (MVAC) elicited a significant response in patients who failed gemcitabine and platinum (GP) chemotherapy. Systemic chemotherapy is the treatment of choice for metastatic, recurrent or inoperable urothelial carcinoma (UC). Methotrexate, vinblastine, Adriamycin and cisplatin (MVAC) chemotherapy was used worldwide as the standard treatment since the first report of its efficacy in 1985 [1]. Since gemcitabine and cisplatin (GC) chemotherapy showed similar efficacy as MVAC but with less toxicity in a large, randomized, multinational and multicentre phase III study of GC. A small number of clinical trials proposed that platinum-based regimens are effective in a significant Several regimens have been investigated in the second-line setting after the failure of GC, including taxanes, vinflunine, ifosfamide, ixabepilone and pemetrexed; [4,5,6,7,8,9] no regimen has yet achieved a competent survival benefit in the second-line setting.
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